<!--{include file="<!--{$tplpath}-->head.html"}-->
<div id="bigmain">
<div class="main03">

    <div class="menu03mainleft" style="height:700px; width:990px; background:#FFFFFF;">
<table border="0" align="center" cellpadding="" cellspacing="0" style="margin-top:45px; border:solid 1px #d7d7d7;">
<td width="430px" height="420px" align="left" valign="middle">
<img src="<!--{$skinpath}-->images/reg_bg.png" style=" margin-left:5px;" />             
</td>
 <td width="435px" valign="top">
 <div><img src="<!--{$skinpath}-->images/reg_bg1.png" style="" />  </div>
 
<form id="feedbacksmallform" method="post" action="/user.php" name="gform">

<input type="hidden" name="action" value="reg" />

<table width="100%" border="0" cellspacing="0" cellpadding="3" style="margin-left:20px;"  class="tablety1">



<tr> 

      <td width="80" align="left">用户名：</td>

      <td> 

        <input type="text" name="username" value="" class="input"/>

        <font style='color:red'>*</font> <div style="padding-top:3px;color:#666"></div>  </td>

    </tr>



    <tr> 

      <td width="80" align="left">密码：</td>

      <td> 

        <input type="password" name="password" />

        <font style='color:red'>*</font>&nbsp;<span>6-12位数字和字母组成</span> 

        <div style="padding-top:3px;color:#666"></div>  </td>

    </tr>


<tr> 

      <td width="80" align="left">出生日期：</td>

      <td> 

       <input type="text" name="year" size="4" value="1990"/>年
      <select name="month" >
      	<option value="1">1</option>
         <option value="2">2</option>
          <option value="3">3</option>
           <option value="4">4</option>
            <option value="5">5</option> 
            <option value="6">6</option>
             <option value="7">7</option>
             <option value="8">8</option>
            <option value="9">9</option> 
            <option value="10">10</option>
             <option value="11">11</option>
             <option value="12">12</option>
      </select>月
       <select name="day" >
      	<option value="1">1</option>
         <option value="2">2</option>
          <option value="3">3</option>
           <option value="4">4</option>
            <option value="5">5</option> 
            <option value="6">6</option>
             <option value="7">7</option>
             <option value="8">8</option>
            <option value="9">9</option> 
            <option value="10">10</option>
             <option value="11">11</option>
             <option value="12">12</option>
          <option value="13">13</option>
           <option value="14">14</option>
            <option value="15">15</option> 
            <option value="16">16</option>
             <option value="17">17</option>
             <option value="18">18</option>
            <option value="19">19</option> 
            <option value="20">20</option>
             <option value="21">21</option>
             <option value="22">22</option>
              <option value="23">23</option>
           <option value="24">24</option>
            <option value="25">25</option> 
            <option value="26">26</option>
             <option value="27">27</option>
             <option value="28">28</option>
            <option value="29">29</option> 
            <option value="30">30</option>
             <option value="31">31</option>
      </select>日
         </td>

    </tr>



<tr> 

      <td width="80" align="left">性别：</td>

      <td> 
      <input type="radio"  name="sex"  value="1" title="男" checked="checked"/><label style="margin-right:25px; margin-left:5px;">男</label>
     
      <input type="radio"  name="sex"  value="2" title="女"/><label>女</label>
        <!--input type="text" name="sex" value="" class="input"/-->

         <div style="padding-top:3px;color:#666"></div>  </td>

    </tr>

<tr> 

      <td width="80" align="left">电子邮件：</td>

      <td> 

        <input type="text" id="email" name="email" value="" class="input"/>

        <font style='color:red'>*</font> <div style="padding-top:3px;color:#666"></div>  </td>

    </tr>


<tr> 

      <td width="80" align="left">手机号码：</td>

      <td> 

        <input type="text" name="phone" value="" class="input"/>
		<font style='color:red'>*</font> <div style="padding-top:3px;color:#666"></div>

        </td>

    </tr>
    
     <tr> 

      <td width="80" align="left">联系地址：</td>

      <td> 

        <input type="text" name="sheng" value="" size="8"/>省
         <input type="text" name="shi" value="" size="8"/>市
          <input type="text" name="qu" value="" size="8"/>区

        </td>

    </tr>
      
      <tr> 
      <td></td>
		<td>	 <input type="text" name="street" value="" size="42"/>
      </td>
      </tr>
    
    <tr> 

      <td width="80" align="left">邮政编码：</td>

      <td> 

        <input type="text" name="code" value="" class="input"/>

        </td>

    </tr>

<!--tr> 

      <td width="80" align="left">年龄：</td>

      <td> 

        <input type="text" name="age" value="" class="input"  />

        <font style='color:red'>*</font> <div style="padding-top:3px;color:#666"></div>  </td>

    </tr-->







	

    <tr> 

      <td width="80" align="right">&nbsp;</td>

      <td height="30">

       
        <input type='hidden' name='act' value='formsend' />

        <input name='groupid' type='hidden' id="groupid" value='1' />

		 <input type="submit" name="Submit" value="" ONCLICK="validate()" class="submit" style=" width:84px; height:30px; border:0px; background-image:url(<!--{$skinpath}-->images/btn_reg.png)"/>

	  </td>

    </tr>

  </table>

</form>


</td></table>


</div>
</div>




	<div class="css_hack"></div>
</div>
<!--{include file="<!--{$tplpath}-->footer.html"}-->